A community-based program that reinforces basic
childbirth and newborn care practices can
reduce a baby's risk of death within the first month of
life by as much as 54 percent, according to a
study in rural India led by researchers at the Johns
Hopkins Bloomberg School
of Public Health in
collaboration with CSM Medical University in Lucknow,
India. The study is published in the Sept. 27
issue of The Lancet.

"Changes in behavior such as preparing for the birth
and skin-to-skin care to keep the baby
warm, breastfeeding and infection prevention practices were
found to significantly reduce neonatal
mortality," said Gary Dramstadt, the senior author and
principal investigator of the study, who led the
research while at the Bloomberg School and is now senior
program officer for neonatal health with
the Bill & Melinda Gates Foundation.

Vishwajeet Kumar, a researcher in the Bloomberg
School's Department of International Health
and first author and co-principal investigator of the
study, said, "This was a unique experiment that
tested a delivery model of preventive practices
co-developed with community members. This was
essentially a community-driven program that aimed to
empower them to save the lives of their own
babies."

The randomized trial was conducted in Uttar Pradesh, a
state where 25 percent of India's 1
million annual neonate deaths occur. More than 80 percent
of infant deliveries took place in the home
and away from the formal health care system. As part of the
study, the researchers worked with
community members to develop simple, culturally relevant
messages to reinforce healthy birth
preparedness and clean delivery, hygienic umbilical cord
care, skin-to-skin care (holding the baby close
against the mother's chest), breastfeeding and keeping the
baby warm.

Community health workers, with support from community
volunteers, worked with pregnant
women, their family members and key community members
through a series of home visits and
community meetings. The behavior-change messages were
incorporated by the community into
traditional folk songs, which served to further promote the
practices and change social norms.

Compared to a control group that received the basic
governmental and nongovernmental
organization services offered in the region, villages that
received the intervention saw a 54 percent
reduction in infant deaths during the first month following
birth. A second group, which received the
same intervention plus a liquid crystal hypothermia
indicator to help monitor the baby's temperature,
had a 52 percent reduction in neonatal deaths.

Robert Black, co-author of the study and chair of the
Bloomberg School's
Department of International Health, said, "This study
adds to a growing body of evidence that community
engagement
to ensure the survival of newborns and acceptance of
specific changes in care practices can
substantially reduce mortality in the very vulnerable first
month of life."

Funding was provided by USAID and Save the
Children-USA through a grant from the Bill &
Melinda Gates Foundation.